Differential diagnosis of submucosal lesions with endosonography

Öz

Background and Aims: We aimed to determine the etiological factors of submucosal lesions seen during upper gastrointestinal system endoscopy utilizing endosonography. Materials and Methods: Our study was done prospectively between December 2008 and May 2010 in the Gastroenterology Department of İzmir Ataturk Training and Research Hospital. Eighty-seven cases with submucosal lesions determined during endoscopy were included in the study. Cases were examined with radial endosonography. Biopsy was performed with linear endosonography when required. Lesions were classified as intramural, extramural, benign, and malignant. Results: Thirty-nine (44.8%) intramural and 28 (32.1%) extramural lesions were observed in the patients. No lesion was observed in 20 cases (22.9%) on endosonography. While 14 intramural and 7 extramural lesions were malignant, 25 intramural and 21 extramural lesions were benign in nature. Thirteen cases were diagnosed with fine needle aspiration cytology (FNAC) with endosonography. Conclusions: Submucosal lesions seen in endoscopy indicate underlying malignant-benign pathology with a high degree of probability. Endosonography as an effective minimally invasive method should be the first evaluation method to remember in the visualization and diagnosis of submucosal lesions.

Anahtar Kelimeler

• Endosonography, esophagus neoplasms, stomach neoplasms

Endosonografi ile submukozal lezyonların ayırıcı tanısı

Öz

Giriş ve Amaç: Bu çalışmada, üst gastrointestinal sistem endoskopisinde saptanan submukozal kitleleri endoskopik ultrasonografi ile değerlendirerek etyolojik nedenlerini saptamayı amaçladık. Gereç ve Yöntem: Çalışmamız, İzmir Atatürk Eğitim ve Araştırma Hastanesi Gastroenteroloji Kliniği&'nde Aralık 2008-Mayıs 2010 tarihleri arasında prospektif olarak yapıldı. Çalışmaya endoskopide submukozal lezyon saptanan 87 olgu dahil edildi. Olgular radial endoskopik ultrasonografi ile incelendi. Gereken olgulara Lineer endoskopik ultrasonografi ile biyopsi yapıldı. Lezyonlar intramural, ekstramural, benign ve malign olarak sınıflandırıldı. Bulgular: Hastaların 39'unda (%44,8) intramural, 28'inde (%32,1) ekstramural lezyon izlendi. Yirmi (%22,9) olguda endosongrafide lezyon görülmedi. İntramural lezyonların 14'ü, ekstramural lezyonların 7'si malign iken, intramural lezyonların 25'i, ekstramural lezyonların 21'i benign karekterde lezyondu. 13 olguya lineer endosongrafi ile ince iğne aspirasyon sitolojisi yapılarak tanı konuldu. Sonuç: Endoskopik olarak izlenen submukozal lezyonlar, yüksek olasılıkla altta yatan malignbenign bir patolojiyi göstermektedir. Submukozal lezyonların görüntülenmesinde ve tanısının konmasında, etkin minimal invaziv bir yöntem olarak endosonografi ilk akla gelmesi gereken değerlendirme yöntemi olmalıdır.

Anahtar Kelimeler

• Endosonografi, özofagus neoplazmları, mide neoplazmları

Kaynakça

1. Humphris JL, Jones DB. Subepithelial mass lesions in the upper gastrointestinal tract. J Gastroenterol Hepatol 2008; 23: 556-66.
2. Hedenbro JL, Ekelund M, Wetterberg P. Endoscopic diagnosis of submucosal gastric lesions. The results after routine endoscopy. Surg Endosc 1991; 5: 20-3.
3. Hawang JH, Saunders MD, Rulyak SJ, et al. A prospective study comparing endoscopy and EUS in the evalution of GI subepithelial masses. Gastrointest Endosc 2005; 62: 202-8.
4. Avunduk C, Hampf F, Coughlin B. Endoscopic sonography of the stomach: Findings in benign and malignant lesions. AJR Am J Roentgenol 1994, 163: 591-5.
5. Yasuda K, Nakajima M, Kawai K. Endoscopic ultrasonongraphy in the diagnosis of submucosal tumor of the upper digestive tract. Scan J Gastroenterol Suppl 1986; 123: 59-67.
6. Rösch T, Kapfer B, Will U, et al. Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study. Scand J Gastroenterol 2002; 37: 856-62.
7. Chen TK, Wu CH, Lee CL, et al. Endoscopic ultrasonography to study the causes of extragastric compression mimicking gastric submucosal tumor. J Formos Med Assoc 2001; 100: 758-61.
8. Ando N, Goto H, Niwa Y, et al. The diagnosis of GI stromal tumors with EUS-guided fine needle aspiration with immunohistochemical analysis. Gastrointest Endosc 2002; 55: 37-43.

9. Chang KJ, Katz KT, Durbin TE, et al. Endoscopic ultrasound guided fine needle aspiration. Gastrointest Endosc 1994; 40: 694-9.
10. Motoo Y, Okai T, Ohta H, et al. Endoscopic ultrasonography in the diagnosis of extraluminal compressions mimicking gastric submucosal tumors. Endoscopy 1994; 26: 239-42.
11. Blay JY, Bonvalot S, Casali P, et al. Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20-21 March 2004, under the auspices of ESMO. Ann Oncol 2005; 16: 566-78.
12. Berman J, O’leary TJ. Gastrontestinal stromal tumor workshop. Hum Pathol 2001; 32: 578-82.